AimIn this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively.Material and methodsBetween March 2015 and March 2019, the results and treatment protocols of 32 patients with a primary mediastinal mass or cysts who were followed up and treated in our clinic were evaluated retrospectively. Twenty-six patients who underwent surgery for biopsy or resection were included in the study.ResultsSixteen of our patients were male and 10 were female. The mean age was 39 years. 80.2% of our patients were symptomatic and 19.2% were asymptomatic and a mediastinal mass was incidentally detected in these asymptomatic patients. The most common symptom was dyspnea with frequency of 38.4%. In terms of localization, the mass was lateralized on the right side in 7 patients, on the left side in 5 patients. In 13 patients, the tumor was located in the posterior mediastinum. 8 patients underwent anterior mediastinotomy and 1 patient underwent biopsy with video-assisted thoracoscopic surgery (VATS). Most commonly a thymus-derived mass was seen. Fifteen patients underwent excision with VATS, 3 thoracotomy, 2 sternotomy and in 1 patient VATS assisted anterior minithoracotomy was performed.ConclusionsMediastinal tumors and cysts have different histopathological features. Robotic surgery and VATS-assisted surgery are increasingly used in surgical excision.
Objective: Esophageal perforation (EP) is a critical and potentially life-threatening condition with considerable rates of morbidity and mortality. Despite many advances in thoracic surgery, the management of patients with EP is still controversial. Materials and Methods:We retrospectively reviewed 34 patients treated for EP, 62% male, mean age 53.9 years. Sixty-two percent of the EPs were iatrogenic. Spontaneous and traumatic EP rates were 26% and 6%, respectively. Three patients had EP in the cervical esophagus and 31 in the thoracic esophagus.Results: Mean time to initial treatment was 34.2 hours. Twenty patients comprised the early group <24 h) and 14 patients the late group (>24 h). Management of the EP included primary closure in 30 patients, non-surgical treatment in two, stent in one and resection in one. Mortality occurred in nine of the 34 patients (26%). Mortality was EP-related in four patients. Three of the nine patients that died were in the early group (p<0.05). Mean hospital stay was 13.4 days. Conclusion:EP remains a potentially fatal condition and requires early diagnosis and accurate treatment to prevent the morbidity and mortality. Keywords: Esophageal perforation, emergency treatment, thoracic surgery ÖzetAmaç: Özofagus perforasyonları (ÖP) kritik , hayatı tehdit eden mortalite ve morbidite riski yüksek olgulardır. Göğüs Cerrahisi'ndeki tüm gelişmelere rağmen bu olgulara yaklaşım günümüzde de tartışmalıdır. Gereç ve Yöntem:ÖP nedeniyle tedavi ettiğimiz 34 hastayı retrospektif olarak değerlendirdik. Erkek hastalar tüm hastaların %62' sini oluşturmaktaydı. Ortalama yaş: 53,9 olarak saptandı. Tüm perforasyonların %62' si iatrojenik nedenlerden kaynaklanmaktaydı. Spontan ve travmatik perforasyon oranları sırasıyla %26 ve % 6 olarak hesaplandı. 3 Hastada boyunda, 31 hastada ise torasik özofagusda perforasyon saptandı. Bulgular:Tedavinin ortalama başlama süresi 34, 2 saatti. 20 hasta erken grup içindeydi (<24 saat), 14 hasta ise geç grup (>24 saat) olarak sınıflandırıldı. Cerrahi olarak; 30 hastada primer onarım,1 hastada özofagus rezeksiyon ve anastamoz, 1 hastada stent ve 2 hastada medikal tedavi uygulandı. Mortalite 9 hastada gelişti %26. Mortalite nedeni 4 hastada ÖP'a sekonderdi. 9 Hastanın 3' ü erken tedavi grubundaydı (p<0,05). Ortalama hastanede yatış süresi 13,4 gündü. Sonuç: ÖP potansiyel ölümcül sonuçlar doğurabileceğinden morbidite ve mortaliteyi azaltmak için erken tanı ve etkili tedavi gereklidir. Anahtar Kelimeler: Özofagus perforasyonu, acil tedavi, göğüs cerrahisiCorrespondence to: M. Muharrem Erol,
Introduction: Video-assisted thoracoscopic surgery (VATS) with non-intubated technique is safely performed under spontaneous breathing and sedation. With this surgery, many complex thoracic surgical interventions can be successfully applied. Aim: We shared the results of our patients who underwent mediastinal biopsy, pleural biopsy, lung wedge resection, pneumothorax surgery, and pleural delocculation with non-intubated VATS. Material and methods: Patients who underwent surgery with non-intubated VATS between March 2015 and May 2020 in our clinic were included in the study. The patients were evaluated in terms of many factors such as age, gender, applied surgical intervention, diagnosis, side of surgery, duration of surgery, and time of hospital stay, and the results were recorded retrospectively. Results: Twenty of the patients were male and 12 were female. Regarding comorbid diseases in our patient group, 13 had extrathoracic malignancy, 7 had hypertension, 6 had heart disease, 5 had chronic obstructive pulmonary disease and asthma, and 4 had diabetes mellitus. Pleural drainage and biopsy were performed in 10 patients and wedge resection in 8 patients. Bullectomy and apical pleural abrasion were performed in 6 patients, mediastinal mass biopsy was performed in 4 patients, and delocculation was performed in 4 patients due to empyema. Conclusions: The non-intubated VATS approach can be safely applied in procedures such as lung resections, pleural or mediastinal interventions, and pneumothorax surgery. With this technique, the absence of intubation and mechanical ventilation facilitates the return to normal respiratory physiology, and we think that the recovery time of the patient, the duration of hospital stay, and treatment costs are reduced.
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